Only a small percentage (3 %) of participants reported that they did not consume alcoholic beverages. Our findings are consistent with those published by Bucur et al. [33], who studied 933 young people (aged 14–30 years, average age 22.12 ± 2.78 years) living in Mureş county and in neighboring Romanian counties, and found 3.75 % abstinence from alcohol. In our study, abstinence was more than four times lower compared with data collected by Shah et al. [34] from 2710 medical students in the USA.
Over 70 % of the young people in our sample only consumed alcohol on special occasions or holidays, indicating that AC was relatively low in comparison with that of young people reported in some studies in England [35–37]. For all categories of alcoholic beverages, the amount consumed was much higher in males, and suggested that females preferred wine over beer or spirits. This factor should be investigated in more detail in future to determine the kinds of beverages associated with different types of drinkers: severe, moderate, and occasional drinkers (AC for energy). Other studies found that wine consumption was not strongly associated with smoking habits and problems caused by AC [38]. Further studies should be conducted to clarify which variables have a greater impact on these associations.
Previous studies have shown that the prevalence of AC and of problems caused by drinking were higher among men than women [39–41]. Our study also found males drank more frequently than females, drank more often to overcome sexual or emotional inhibitions or for courage, and had over twice as many AC-related problems in concentration at work/school. In addition, the percentage of females who did not consume alcohol at all was 2.7 times higher than that of males. Interventions to raise awareness among parents, schools, and society in general are necessary, particularly as currently, there are more permissive messages about AC for men whereas women receive higher social sanctions for drinking.
Studies have shown that people who have ordered and well-structured daily lives (e.g., who are in a stable couple, are parents, and have a paid job) tend to drink less than people who are not involved in a relationship, have no children, and no job [42]. Our sample included 12.9 % of participants who were married, 8.3 % who had been in a consensual union for more than 1 year, 4.6 % who lived alone, 8.9 % who had children, and 2.6 % who were unemployed and not attending a higher education institution. We did not identify significant correlations between AC and these variables. However, we found that young people aged 23–30 years, most of whom did not live with parents or a partner, drank more often, drank more frequently to overcome sexual/emotional inhibitions of for courage, and had greater AC-related problems concentrating at work or school. This indicates a positive impact of family life, which imposes a certain structure and order. It is also important that future studies consider the advantages and disadvantages for young adults living on a university campus.
A survey conducted in Germany, Bulgaria, Poland, and the UK (2007) and in Slovakia (2008) with 2529 university student freshmen (mean age 20.37 years) found an association between perceived stress and depressive symptoms and problem drinking [43]. In the context of AC, the problem may not be stress, but rather the coping mechanism for stress [44].
In our sample, the types of accentuated personality traits influenced attitudes and behavioral patterns related to AC to a certain extent; for example, AC was correlated with Uncontrollability and Exaltation. In particular, significantly accentuated Exaltation was significantly correlated with AC. It might be that those whose emotional sphere oscillates between enthusiasm and despair or euphoria and discouragement use AC as a coping mechanism.
We did not identify a significant correlation between significantly accentuated Anxiety and AC as we expected, which was inconsistent with previous studies that found a connection between high anxiety sensitivity and AC used as a coping mechanism [45]. In our study, accentuated and strongly accentuated Demonstrativeness were much lower than the levels found in a previous study with adolescents [46]. This suggests that with age, the “hormone storm” decreases, acceptance of body metamorphoses increases, and the nature of relationships with the outside world are reshaped, leading to a decrease in the need to attract attention through demonstrative behaviors, particularly those on the ludic register (bravado, lies and so on).
Among participants who had AC-related problems with concentration, most belonged to the category with significantly accentuated Demonstrativeness. This group drank more frequently to overcome inhibitions. The desire to be noticed and accepted by others is a need experienced by all people; however, the manifestation of this need and the way in which attention is sought are important. For example, Demonstrativeness in art is necessary and an advantage, whereas maladaptive manifestations of Demonstrativeness are represented by AC, drugs, or membership of certain subcultures.
Participants with Hyper-perseverance and Uncontrollability drank more often to overcome inhibitions. People with uncontrollable personality traits tend to be pleasure-driven and have a low capacity to comply with an organized lifestyle or diet, which might explain why AC was more frequent in that group. The profile of Hyper-perseverance (abnormal perseverance with increased susceptibility, stubbornness, anxiety, and fear) is a good fit for AC.
Our findings showed that people in the Hyperthymia and Cyclothymia categories most commonly drank for the first time out of curiosity or boredom. Previous studies have reported that hyperthymic people are predisposed to alcohol misuse [47, 48]. It may be that characteristics of people with hyperthymic tendencies, such as cheerfulness, exuberance, intrusiveness, lack of inhibitions, overconfidence, grandiosity, and high energy levels mean they more often experience states of boredom and curiosity, which they attempt to resolve with AC. The affective lability of people with cyclothymic traits (oscillation between contradictory emotional states) means they may engage in AC due to boredom, particularly if they experience feelings of worthlessness, isolation, loneliness, and minor episodes of depression.
Generally, people drink for a reason. AC has direct chemical effects on the body, as well as indirect effects such as reducing psychological tension, improving mood, and acceptance by peers. In our sample, AC most commonly occurred with a group of friends, indicating AC was used as a way to socialize. AC with a group of friends was predominant in males, whereas in females, AC was more common with boyfriends and with family. This suggests that men tend to be social drinkers, and women tend to drink more in dyads or under family supervision. In Romanian society, in general, women are more heavily criticized than men if they are seen in public smoking or consuming alcoholic beverages.
The reasons given by young people in our sample for first consuming alcohol were similar to those revealed in other studies [49, 50]. Curiosity was a common reason for first trying alcohol. Females first tried alcohol more often out of curiosity or boredom and males mostly tried AC to be like their peers/friends. Therefore, it may be that women tend to drink to feel the effects of alcohol, have fun, improve their mood, relax, or to escape boredom, whereas men drink to be accepted by their peers.
In the youngest age group (18–22 years), AC was most common with a group of friends, whereas in the older age group (23–30 years), AC was most common with family. This is consistent with the results of previous studies, and suggests that age-related changes of status influence the preferred medium of AC [51]. For younger participants, AC was a modality to socialize with a group, and for older participants, was a modality of relaxation with a smaller group (i.e., family). Similar to other studies, we noted that pressure from peers/friends and curiosity may be predisposing factors for AC [52].
The AC pattern of young people is influenced by that of their families [53, 54]. AC on different occasions occurred with family in over half of the cases. Young people’s daily and weekly AC occurs with family in similar percentages. This highlights the importance of the family environment in terms of the formation of attitudinal and behavioral patterns in general, and of those concerning AC in particular [55, 56]. Parents should also monitor their children, as some young people tend to drink at home when parents are away [57].
The limitation of AC in young people is a major responsibility, particularly as studies have found correlations between AC and unprotected sex, which increases the risks of unplanned pregnancies or of sexually transmitted diseases [58].
As adolescents’ brains are still developing, alcoholic beverages should not be served or sold to people aged under 21 years, or even under 24 years. The age of 18 years represents the coming of age in Romania; however, as the limit that regulates the selling of cigarettes and alcoholic beverages, this age is too young. Furthermore, research in Piteşti (Argeş county) in Romania has shown that respect for the law is relatively low [59].
An initiative that contributed to the decline of AC in the UK was Challenge 21 and Challenge 25, introduced by the British Beer and Pub Association (BBPA). Despite the fact that the minimum age to buy alcohol and cigarettes in the UK is 18 years, customers attempting to buy age-restricted products are asked to prove their age if, in the retailer’s opinion, they look under 19, 21, or 25 years [60]. This requires legislative measures as well as public health educational programs with clear explanations of the reasons why AC is not advisable, at least until that age. In addition, the explanations parents or teachers provide to young people usually include reasons such as “you are not allowed to drink because you are a kid,” “because it is illegal,” “when you earn your own money you could drink,” and so on. These statements do not offer helpful information about the harmful potential of alcohol, especially in this period of growth and development.
Another way to reduce AC through acknowledging negative consequences is to involve pharmacists. Pharmacists could disseminate brochures, flyers, or other information materials with attractive designs and friendly illustrations/text on this topic to their clients. In the UK, a randomized controlled trial was conducted with people who consumed alcohol that involved the pharmacist community, based on a brief intervention [61].
Teaching young people about healthy coping strategies may be helpful in reducing AC, including listening to music, going out with a friend (e.g., shopping, a movie, dining), spending time outdoors, playing with a pet, praying, or going to church.
Limitations
Our study has some limitations. The population in our study cannot be taken as representative of all young adults in Romania. However, it can be considered representative of young people in higher education institutions, who live with parents, and who are childless. We did not collect information on participants’ regular daily schedules (e.g., how they spent their leisure time). In addition, our category “drink alcohol only on weekends” did not capture occasional binge drinking, drunkenness on weekends/at parties, or recreational alcohol users. Further studies are necessary to clarify the variables that have greatest impact on AC. Future studies should also use a qualitative design, such as individual or focus group interviews.
It is possible that our participants tended to conform to perceived expectations, and therefore AC was identified at lower levels than actual levels. In Romania, studies on alcohol and drugs with participants who are not known consumers (non-hospitalized, have not requested support) are less common compared with other countries such as the UK. In addition, the specific cultural matrix of the former communist bloc in Romania should be considered, as this imposed population conformism. Our participants were born around the time a democratic, liberal system was introduced (1989) and were educated by parents and teachers who were brought up in a society where socially desirable behavior was mandatory. The stigmatization of people who use alcohol excessively, especially women, might therefore have caused underreporting of AC.
In addition, data for the Schmieschek Questionnaire must be interpreted prudently due to the low internal consistency of the subscales. We did not collect information on the role of the family environment and parental control on AC of young adults.
A study conducted in Romania with a representative sample comprising 1062 parents and including qualitative data from 26 interviews with parents who came from families where at least one parent was an alcoholic, identified lower probability of AC in adolescents and adults who had emotionally and affectively available parents in the first 5 years of life, along with consistent and sustained discipline [62]. A study conducted in Germany with 59 inpatients aged 24–70 years who were addicted to alcohol found a high prevalence of insecure attachment [63].
